Permit n CITY OF TIGARD MECHANICAL PERMIT
F'� g
r. COMMUNITY DEVELOPMENT Permit #: MEC2013 -00161
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03!25/2013
Parcel: 2S 111 DC08800
• Jurisdiction: Tigard
Site address: 15765 SW OAKHILL LN
Project: Swanson Subdivision: SUMMERFIELD NO.10 Lot: 569
Project Description: (1) gas insert, (1) vent and (1) fuel piping
Contractor: GO SALES INC Owner: SWANSON, LORENE J
14210 SE STARK ST 15765 SW OAKHILL LN
PORTLAND, OR 97233 TIGARD, OR 97224
PHONE: 503 - 256 -3473 PHONE:
FAX: 503 - 254 -1011
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 03/25/2013 $23.32
Type of Use: SF Chimney /Liner /FlueNent 03/25/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 03/25/2013 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 03/25/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 03/25/2013 $29.21
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is i
s pe t s ssued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1 p J jp j1 A Permittee Signature: D 1 PPtI e Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar.22.2013 08:55 AM PORTLAND FIREPLACE SHOP 503 254 1011 PAGE. 1/ 2
Mechanical Permit AnolielatICEIVED
City of Tigard Received S Permit Nn
h' Datcmy: 3 rotS I3 MECAct 3•vOrlG I I
13125
Phone 5 503.711.2439 F 03 598.1960' t -' 5 2 013
Other Permit:
Plan Review
t w L ine : a so � 9 �[TY OFTIGARD eau,ea�ynrr: r & I S taf atioe
Ivotirtt�/n4elnoa:
I 1 !TIDING DIVISION - "
TYPE OR WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
❑ Ncw construction Addition/tlhetation/replaeement Mechanical permit fees* are based on the value of the work
performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
li( I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For :pedal Wonnaatoe use thrall=
❑ Multi-family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION • Hating/ /cooling:
_ Air conditioning
Job site address: / S 7 (,c S W ail? ell /4 nZ (requires sito alas showingpincement) 46.75
Furnace 100,000 BTU (ducts/vents) 46,75
City/State/ZIP: -"\--j -I f D 7 a�i� Furnace 100,000+ BTU ( ductrdven s)
54.91
Suite /bldg. /apt. no.: P roject name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hut water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in- duct, suspended, etc. 46.75
Flue/vent far any of above 23.32
Subdivision: Lot no.: Olhcr. 23.32 1
Tax map/parccl no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert I 33.39 , 3'),3
Ei J i/\_ (.4 t ii l /L. L ' 7 / .C'.1 I /pj i - V Flue vent for water heater or gas
i t' IW 23.32
d Log lighter (gas) 23.32
wood/pellet stove , 33.39
Wood fireplacc/insert 23.32
Chimney /liner /flue/vent \ 23.32 1.:7 L
❑ PROPERTY OWNER I 0 TENANT
Other: 23.32 1
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: ( ) Fax' ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT Zi CONTACT PERSON Atti %ravels ace fans 23.32
1 Other: 23.32
Business name: GI 0 A-t-/ r' I RC , Fuel piping:
Contact name: r i c-, (, _ {l 7 � 4 ��` $14.15 for first tour, $4.03 for each additional
Address: 1 Z ( 0 1 a)c S 1 i L St" Furnace. etc. ,
City/Sta Ii o�-1 dvu 012.. t 7 3 3 Wins /sus pump nde
Wall/suspendedlunit heater
Phone: (Sa3 ) (vga3 -7 Fax: : (59 ) ,z5- V-7 G // water heater
Fireplace I /1
P.mail: Kf`I QG11fi'i ( JO- 4 6 , Cbl-Ay Range . .
' CONTRACTOR Barbecue
Business name: 60 7 J''� /!7 . Clothes dryer (gas)
Othcr.
Address: 1 2_ 5s." , „k "tJA MECHANICAL PERMIT BEES'
City/State/ZIP; pP,^ftR „Gl p 1) .233 Subtotal 7A ■ g c,,
Minimum permit fee ($90.00) 4 3 b
Phunc: (y C 3) 663 -995 f ' I Fax: (5P3),,9,..,5 /0/7 Plan review (25% of permit fee)
CCB lie.: 1 9 4 . 5 State surcharge (12% of permit fee) I b . $ D
/ � y l TOTAL PERMIT REF. j CO : I f /� J \ lab permit application expbea Ira permit b Nor obteleed wtmin ISO
/
Authorized signature: days after It bat
has s accepted as tomplete.
I Print name: / 4/ 1 .-. 7 k J 6 r ° L , r f_„Y� Z
7 Date: 3 —z I • Foe methodology set by Tri•Cuuaty Building tndwuy Service Board
I:lnuitdingWumiuUdere c ,mitApp.doc 02/07/12 `/ 440-4617T (I b01/CIX,VWLn)